That's why I think it will be best to make good grades and find out while in school. I've had general dentists on here say general dent is awesome, making 200k+ on 4 day weeks while the other half or more say avoid general dent due to a much lower income on average than specialists and stuff. Specialists all say specializing is usually more worth. On dentaltown, most general dentists seem to think the future isn't too bright and one told me to try to specialize if possible. Finally, the only good data out there is the ADA but that's for people who own practices (both general and specialists). Who knows how hard or easy it may be to own a practice in the future?
Latest Annual Net Income of Specialists....Enjoy
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Firm was correct about everything he said. In fact, the majority of the orthodontists agree with him more than with me. He (and the majority of the orthodontists) and I target 2 very different populations: the top 20% income earners vs the 80% average to low income earners. The fast growing Hispanic population and high influx of immigrants from other countries in recent years are the engines that drive my offices.
I think I read another post that you were asian (if not my bad). Do you speak spanish as well? Is that an issue?
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I took 3 years of Spanish in HS. All but 1 of my staff speaks Spanish.
Oh ok so is it mostly your staff that communicates in Spanish with patients? Or was 3 yrs enough to make you conversationally fluent?
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Yes, my staff do most of the talking so I can focus on the patients' treaments. Most of my Hispanic patients speak fluent English.
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Charlestweed is a great orthodontist and businessman. He was smart enough to create a path to success, so it's possible to be successful doing ortho. I just wasn't as an adept businessman as he was/is coming out of school and most new grads aren't. He has set up a unique practice model that works for him. I would suggest that you set up a unique practice model that works for you, this won't be taught to you in school or by a consultant.
He also started longer ago correct? Not that his success isn't amazing or anything, but the market was better back then wasn't it?
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Yeah, I think that he got out in the late 90's or early 2000's. I got out in 2006. It is just different markets. There were things that you could do in my 2006 market that you can't do now, like take out a million dollar loan without a job.
Yea hope it doesn't get way worse in 4+ years
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Doesn't @charlestweed just offer a lower price to lower income populations? It's an interesting business model, one that seems like it would rely on volume, possible Medicaid. The benefit to being a specialist is you can charge a higher fee for what you are doing. I know a GP that does a ton of ortho by just slashing the fee to $2500 and marketing. You don't need a $300,000 residency to be able to do that.
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It's between 35-40%. That's because I charge low fees. If my fees were higher, the overhead would be as low as 20-25%. When you see 60-80 patients (assuming that each patient pays $120-150 per visit) a day for a corporate chain and you get a per diem rate of $1300-1600/day, that means you get paid less than 20% of the collection. So if you know how control your overhead at your own office, you can make 2-3 times more than working for someone else.
Staff salaries are the largest percentage of the overhead. I keep the overhead low by hiring mostly part time employees. I have 3 F/T employees: an office manager, a lab tech/assistant, a receptionist/assistant. I hire other 8 P/T chairside assistants only the days (12 days/month) that we see patients. I get these P/T assistants from the dental chain and other private ortho offices. I choose to work and Saturdays and Sundays for 2 reasons: 1.These P/T asisstants are usually off on the weekends so they come to work for me. 2. With the abundant number of P/T assistants I can get, I can book 1.5 -2x as many patients on the weekends. So the production for working 6 weekend days a month is the same as the production for working 10-12 weekdays.
Working at a busy dental chain has taught me how to run an understaffed office efficiently. I learn how to practice 2-handed dentistry on most occasions. Unlike the doctor on this youtube video, I bond the whole arch by myself while my 2 assistants work on other patients. So we can work on 3 patients at the same time, instead of 3 of us working on 1 patient. I am sure this doctor charges very high fee so he has the luxury of having the 2 assistants helping him out...and having a much lighter schedule than mine.
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Thank you but I am actually the opposite of what you think I am. I try to keep the overhead low because I have poor business skills. I worked for a dental chain for 4 years before I finally had the courage to start my first office. Most orthodontists have big plans to grow their practices. So they spend a lot of money to build a large state-of-the art office to meet their vision for growth. They are concerned that if it's too small and low tech, it may not allow their practice to grow fast enough. They think of "growth" when they set up their practices. I, on the other hand, think of "possible failure" when I set up mine. So I try to keep everything small and cheap. In case it fails, I simply walk away with a minimal loss. Because of a low expectation to begin with, the stress level in running a new office is much less....it's actually fun.
Others target mainly the top 20% income earners. Many hire professional consultants to do demographic search to make sure that the practices they plan to set up are located in the upper income area. So everybody is competing against each other for the same tiny population of top 20% income earners. I, on the other hand, target the other 80% of patients, whom most other private ortho practices don't want to treat....ie medicaid, HMO, low pay PPO plans, low fees etc. To me, charging low fee and having something to do is better than having none. Getting paid a little is better than zero. It's actually more depressing to sit around doing nothing and still have to pay rent and other bills. Having more patients, who accept the tx, means you have more chance of getting more word-of-mouth referrals. Ortho is not like general dentistry, your patients don't stay with you forever. They are gone when you finish their tx. So you have to keep on starting new cases in order to keep the income stable. So the more patients you accept and make them happy, the more referrals you will get. The more patients you turn away (because your office doesn't accept their insurance plans), the less people who will hear about your practice. It takes time and a lot of hard work to build your reputation.
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No, the benefit to being a specialist is you can advertise that your practice is limited to orthodontics so other GP offices, insurance companies, and existing patients will refer patients to you. A gp can only get ortho patients from his own practice, which is not enough. That's why it's worth spending 300k and 2+years in school.
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THIS.
Ortho has always been in the back of my mind but I am not gonna carter my 4 years of Dental school/do Ortho research just to realize it's financial suicide.
at least pretty much all the dental specialties have good hours except for oral surgery in a hospital (but most people who care about lifestyle/income do private practice T&T)
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For Ortho the hours aren't the concern, it's whether the field is gonna make sense financially for the next 30-50 years. Are the hours for oral surgeons in private practice similar to that of a GP or more so?
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Yea supposedly. Hopefully an omfs chimes in but one I talked to told me the whole OMFS having bad lifestyle isn't really true unless you're in a hospital. He originally was interested in doing the cool procedures in a hospital but over time realized he valued lifestyle and financial benefits a bit more. Also mentioned that overhead is lower in OMFS than general which is why even if generals do a lot of teeth extractions OMFS usually come out on top. Finally, on old reports (from 2003ish?) they did the whole pay per hour thing and for the dental specialties listed, they were all at 36 hrs (with OMFS having largest hourly pay). I honestly don't see why a private practice oral surgeon would choose to have harsh hours if they can make more than medical specialists with the hours of a general dentist (from a financial point of view, not out of benefitting people or interest in the occupation).
Ortho and GD lifestyles are both good, but I've read that even if lifestyle and pay is equal, ortho is nice because you won't be bent over as much so your back won't be as taxed compared to general dentistry. Also patients aren't really in pain in your office so it's an all around happier atmosphere. Hope more specialists can add to this or correct me if I am wrong.
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Wow very interesting, I agree would be great to hear from an OMFS/someone who knows first hand if this is true.
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You spend 4-6yrs to get a full scope of practice. Most don't want to lose that. Also, it takes years to build up a referral system where you can just do T+T. Most OMFS supplement their income with hospital based procedures in order to to A. Get their name out there B. To couple their income. No easy road in any field these days. That said, based on lifestyle alone, I would have to say ortho beats every healthcare profession by a longshot. As long as you can stray away from major cities, you will do very well. I have a friend in Florida who associated and bought into/bought a practice from a retiring ortho clearing 650k a year a few years out of residency on a 4 day work week. The kicker in ortho is the relative ease the profession has on the body. I contemplated going in just for the lifestyle, but I realized that there is more to life than just $. Also as the saying goes, do what you love and the money will come.
Well I mean the four day week applies to all dental stuff if you're private practice, and we go by medians and averages not single data points for more accuracy. Everyone knows a super rich dentist but doesn't change the fact that median owners is like 180k. Finally, all specialties have residencies, but going by medians or averages, you make up for the 4-6 years decently quickly. I agree with your thing about being easy on the body, but as far as lifestyle goes they're all good. Plus other residencies don't seem to have as many for money residencies like Ortho. In fact omfs pays you during it. Not to mention Ortho seems to deal with more saturation than others due to these for profit residencies opening left and right.
If you browse the forums there are some omfs posts. Idk just seems like there's more optimism in that route than Ortho and general. Peds seems to be safe choice too if you like the patient base.
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Ya but in a way we are already masochists for choosing d school over a job you can use straight out of bachelors. Just depends on your value of four years. Also at least peds won't be enroached on since it seems a big part of it is patient base not only procedure
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No peds for me haha, having my own kids will be quite enough as is.
You're right about there being more optimism in peds but trying to decipher how much of the ortho doom and gloom is legit and how much is just making mountains out of mole hills.
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Thanks for the response. Keeping overhead under control is not a sexy topic, but if you want to make a good living as an orthodontist it's critical. When you go to the AAO meeting and listen to the lectures and walk the exhibitor's hall it's all about new technology, marketing and (unfortunately) selling snake oil (Damon, Acceledent etc). You don't see a lot of focus on controlling overhead because that doesn't make ortho supply companies, marketers or gadget-makers any money.
Part-time staff is a great idea. Keeping things simple and efficient like you describe is huge. 35-40 percent with low fees is amazing! With low overhead it works to have low fees. With low overhead and average fees you can start fewer patients and do well. It just depends on your business model. What I see happening is that orthodontists are quick to both engage in a war over fees and also to try to outdo each other in terms of having all the latest tech and the coolest office and most over the top marketing. Over time that leads to higher overhead without healthy fees to offset. I know this kind of thing happens in other professions to some extent, but ortho seems especially bad.
Great post, CharlesTweed!
one word : invisalign
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I've heard of recent endo grads working full time making 225-250k in the Midwest (Wis, Illinois, Kentucky)..does anyone know if figures like this are accurate/realistic?
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These are numbers straight out of residency, no real work experience.
I think this hurts the most for the patient base of "adults who need braces". Betting that a large chunk of people would rather have suboptimal care that's hidden than perfect teeth with braces for 1+ years
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One thing always pops up in my head when I read this - not just you but other orthos and even GPs wondering if they should work evenings/weekends - how are you getting those PT assistants? How well do they do and how long do they stay on? Maybe it's a plus of how saturated LA is, but in my experience, it seems like the type of assistants that opt to work these alternative hours are generally unreliable or inexperienced or young. Not that there's anything wrong with the latter two, but it seems having the normal 8-5/m-thu practice tends to attract staff that are more normal or reliable. Or for instance the part timers decide after a few months turns out they don't like working evenings or Saturdays. Or they treat it as a second job instead of their main priority.
Or maybe looking in a positive light instead, maybe a person that needs a second income is one to be more reliable or hardworking?
I have not personally opened or interviewed for alternative hours myself, but that's just what I hear. Thoughts?
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These P/T ortho RDA's work (or used to work) with me at the chain. Since they are already familiar my working style, everything goes smoothly when they help out at my office. When I don't work at the chain, these assistants are also off...so they come work for me. Since they have a regular job at the chain during the weekdays, it's easier for me to get these assistants to work for me on the weekends than on the weekdays. I pay them a full day wage ($120-160) for working only 4 hours/day (8am-12noon on weekends, 2-6pm on weekdays). That's a big incentive they can't refuse.
When I started my first office, I asked one of the assistants to follow me to my office after we were done with our job at the chain at 6pm. I paid this assistant $50 for helping me 1-2 hours (from 6:30pm-8pm). Since I didn't want to quit my good paying job at the chain, I had no other choices but to work late hours at my newly built office. It wasn't stressful at all. I actually feel good when I am busy at my own office . Who doesn't want his/her own practice to be busy and successful? I stopped offering late hours 2 years later.
I prefer the chain's RDA's over the private ortho offices' RDAs because they are better and faster. They can handle high volume of patients and busy schedule very well. When I purchased a 2nd office in 2009, I had to let go both of the slow existing RDAs and replaced them with my faster RDAs.
Like their orthodontist bosses, the ortho RDAs face oversaturation problem here in CA as well . Since many ortho offices can't offer their RDAs a full time job, the RDAs have to find P/T jobs elsewhere to keep themselves busy. A lot of RDAs want to work for me on Saturdays and Sundays but I only have 6-7 chairs at each of my offices. So the most number of P/T RDAs I can hire in one day is 5 (since I already have 3 F/T employees). I have a couple of back up ones who will fill in when someone calls in sick. Another advantage of hiring P/T employees is I don't have to offer them any benefit such as 401k, sick pay, holiday pay.
The only one that is worth keeping is the office manager. Everyone else can be replaced.
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Thank you. Having a low overhead office + a good paying associate job make starting an office from scratch fun and easy.
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Invisalign shouldn't hurt the ortho offices that target mostly low income patients. The reason many patients choose to get braces over Invisalign is affordability. With the traditional fixed bracket system, the patients only need to put a small down payment amount and make small payments over the period of 2 years. Since the initial lab cost for Invisalign is very high, many patient can't afford to put a huge amount of down payment at the initial impression visit.
1 in 3 Americans can't come up with $2,000—here's how much you should be saving
Oh true didn't take into account cost.
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For your computerless office, did you take before and after pictures? Where did you store them? How did you make appointments without a computer?
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Yes, of course, before and after photos are the most important orthodontic records. I often use the initial photos to impress my patients by showing them how bad their teeth looked and how much I have accomplished in a few months...a simple way to build the patient's trust. I store everything inside the patient's chart: initial/final photos, pan, ceph, tx note, signed med hx, signed consent form, signed tx plan form, signed final debonding form, financial contract, financial ledger. As an HMO provider, my offices get audited every year so it's important to have all these documents inside the charts. I wonder how other doctors store these important signed documents when they use paperless charts.
I use a $10 appointment book to schedule all my patients. A day before, my office manager pulls out all the charts and calls the patients to confirm their appts. She then notifies me the total number of patients, starts, and consults that I'll have. If I have an unsually busy day, I call an additional P/T RDA to help me . Here are the steps when the patient checks in:
1. Pt signs in.
2. Office manager collects monthly payment from the pt. No need to send out bills. No stamp. No envelop licking.
3. office manager schedules the next appointment, which is 4 weeks away. Since I have very efficient chairside assistants, every patient gets a 15-minute appoinment slot. A final debond procedure has to be scheduled early so we have time to make and deliver retainers the same day.
4. Office manager puts the chart up. This is another advantage of paper charts. If I see the stack of charts getting bigger, I know I am behind so I try to work faster. I don't think you know how behind you are and how many patients are waiting to be seen if you use digital charts.
5.One of the chairside assistants grabs the chart and calls the pt in for treatment.
6. Pt goes home.
Paper chart system is fast and simple. Pt signs in and 5-10 minutes later, he is on the chair getting treatment. No need rely on the outside tech support when computer system is down. More freedom and less headache for me.
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Ah I see, paying a full wage for the few hours you are open is definitely good incentive. That answers the other point regarding benefits too - while most would try to find a FT job with benefits, the great PT wage is definitely a good deal.. plus, most people compare and judge how well they're compensated by wage anyways, not so much benefits ("how much per hour?").
I would say just the same too that having a FT office manager and FT lead assistant probably are the most important to keep in terms of balancing cost with a smooth flowing practice.
Also, very interesting regarding all paper charts, film panos... definitely a different approach to the 'up and coming' practices nowadays
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While this is true now, aren't you worried that with further innovation the cost of Invisalign will drop low enough to attract your low-income patient base?
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Smile Direct Club.
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Nah. I remember Invisalign came out around the same year that I started my ortho residency. At that time, we were all worried that Invisalign tx fee would get cheaper and eventually put all of us out of work in a few years. Now, fast forward to 15 years later, I still don't see the price dropping. The overhead for doing invisalign tx actually increases. Many orthodontists and dentists stop using the cheaper polyvinyl siloxane impression material. They now use the much more expensive intraoral scanners to send the lab cases to Invisalign. Technology actually hurts the orthodontists more than it helps them. On his previous post, Firm said that he had to spend $200-300k in Invisalign lab fees to train himself. I'd rather use that amount of money for a down payment on an apartment so I can have a nice passive income when I retire. Increase in the doctor's office's overhead = higher tx fee = less affordable for the patients.
A couple of years ago, the corporate chain, that I currently work for, flew all of us to Dallas to take the Invisalign certification course so we could start offering Invisalign tx to the patients. That was a big mistake and a waste of money. The patients continue to go for the cheaper traditional brackets because they cost half as much and the required down payment is much less.
I am more worried about the increase in the number of new ortho grads (due to the opening of new ortho programs) than about Invisalign taking away our job.
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Very interesting, although it seems Invisalign would be a bigger issue for the Ortho's targeting the top 20% of earners than through your method. I have to get braces (ironically after having Invisalign) and my local Ortho quoted me 5k, so I'm waiting to start school to get the school discount.
If you were a D1 now, would you still pursue Orthodontics?
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Yes, I definitely would. If I were a today new grad ortho with 500-600k debt and couldn't find a good stable job at a chain (due to oversupply of orthos), I would try to get several low paying jobs at several GP offices, that pay me % of collection. I remember when I first started in-house ortho for my sister, who is a GP, I made very little (a lot less than a GP's salary) during the first 12 months. Now, it is my highest paid job....better than what I make per day at my own office.
A lot of GP owners here in CA want to invite the orthodontists to come work for them. Who wouldn't want to earn additional passive income by keeping everything in-house? But many new grad orthos turn down the jobs because they all want guaranteed per diem rate of $1000+ a day, which most GP owners cannot afford to pay. And then these new grads come to this forum and complain that they can't find jobs...and the jobs that are available are bad. Isn't having a bad paying job better being unemployed?
Below is an interesting post that was written by a very successful orthodontist, who doesn't do invisalign. In addition to running a busy ortho practice in WA, he also owns an ortho supply company that sells low cost wires and brackets. Other orthos have comlained about the rising cost in running a practice. I, on the other hand, have experienced the opposite. Thank to this orthodontist and many other supply companies like his, I've saved at least $3-4k in supply cost every month.
Orthodontic Overhead Control and Treatment Efficiency: Reasons why I don't do Invisalign
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IMO it's more of a risk not to be highly skilled in clear aligners. I don't use Invisalign, I use Clear Correct. Most dentists/orthodontists aren't going to spend the $200-300,000 and the time to become as good with clear aligners as they are with braces. So they will continue to offer braces, while a small number of providers are highly skilled with aligners. Supply and demand will produce all the patients that I need. In addition, I take advantage of volume discounts which if you get far enough ahead makes it very difficult for others to catch up. It's getting harder to make an ortho office successful. Overhead increases, Fees decrease and assistants can only see so many patients. Aligners allow you to see more patients with the same number of staff. Chris Bentson will show that heavy aligner practices produce more per full-time equivalent. Plastic never gets sick, never asks for health care, never complains about work.
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I guess each orthodontist has his/her own unique business model depending on where he/she practices. I think if you have unlimited supply of patients who want invisalign tx and a limited supply of experienced ortho RDAs, then Chris Bentson’s business model works well.
You see, here in CA, I have a limited number of active patients and an oversupply of part time ortho RDAs. I only have around 800 active patients and I only need to work 11-12 days/month to take care all of these patients. I have plenty of free time to post on this forum. My office is far from reaching its maximum capacity. That’s why I still have to keep myself busy by working for a chain the other 11 days/month. That’s why I try to keep everything low tech so I can assign tasks for my F/T staff to do to keep them busy.
Some like to pay big bucks on new technology (ie Invisalign, intraoral scanners, Suresmile, self-ligating brackets etc) to replace human labor (ortho assistants). Some earn their profit by using cheap human labor (ortho RDA’s salaries) and avoiding expensive high tech gadgets.
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